- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $5,754.40 / $11,220.18
| Facility | | $1,737.80 | $5,754.40 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $977.24 / $1,479.11
| Facility | | $812.83 | $977.24 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $12,302.69 / $19,054.61
| Facility | | $4,897.79 | $12,302.69 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $25,703.96 / $25,703.96
| Facility | | $56.23 | $25,703.96 | $25,703.96 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $2,570.40 / $2,570.40 / $2,570.40
| Facility | AS | $2,570.40 | $2,570.40 | $2,570.40 |